Examkin

Question

Difficulty: HardPharmacological and Parenteral Therapies

A client with suspected bacterial meningitis is admitted to the intensive care unit. The healthcare provider prescribes a stat dose of intravenous ceftriaxone and a continuous infusion of 0.9% Sodium Chloride0.9\% \text{ Sodium Chloride} at 100 mL/hr100 \text{ mL/hr}. The client arrives from the emergency department with a single peripheral intravenous catheter currently infusing Lactated Ringer's solution at 100 mL/hr100 \text{ mL/hr}. Based on these findings, which of the following is the priority action by the nurse?

  1. A
    Administer the ceftriaxone via the closest Y-site of the infusing Lactated Ringer's solution to ensure rapid antibiotic delivery.
  2. B
    Withhold the ceftriaxone and contact the healthcare provider to request an alternative antibiotic due to intravenous fluid incompatibility.
  3. Stop the Lactated Ringer's solution, initiate the prescribed 0.9% Sodium Chloride0.9\% \text{ Sodium Chloride} using new intravenous tubing, and administer the ceftriaxone.Answer
  4. D
    Pause the Lactated Ringer's solution, flush the catheter with 10 mL10 \text{ mL} of sterile water, administer the ceftriaxone, and flush again.

Answer

Stop the Lactated Ringer's solution, initiate the prescribed 0.9% Sodium Chloride using new intravenous tubing, and administer the ceftriaxone.
Ceftriaxone is contraindicated for administration with calcium-containing intravenous solutions, such as Lactated Ringer's, due to the high risk of forming lethal calcium-ceftriaxone precipitates in the client's bloodstream. To safely administer the stat antibiotic for a life-threatening infection (meningitis), the nurse must stop the incompatible fluid, change the intravenous tubing to prevent mixing with residual fluid, initiate the newly prescribed compatible fluid (0.9% Sodium Chloride0.9\% \text{ Sodium Chloride}), and administer the ceftriaxone immediately.

Step-by-Step Solution

1
Identify the clinical priority based on the diagnosis.
Bacterial meningitis is a life-threatening neurological emergency requiring immediate (stat) antibiotic administration to prevent severe morbidity or mortality.
Delays in treatment directly correlate with poorer client outcomes in meningitis.
2
Assess for pharmacological incompatibilities.
Ceftriaxone is recognized as incompatible with any calcium-containing solution, such as Lactated Ringer's.
Ceftriaxone binds with calcium to form particulate precipitates that can cause fatal emboli in the lungs and kidneys.
3
Evaluate the current intravenous access and prescribed orders.
The client has a single IV line running the incompatible Lactated Ringer's, but the provider has already prescribed a continuous infusion of compatible 0.9% Sodium Chloride.
The nurse must transition the client to the newly prescribed, compatible fluid.
4
Determine the safest procedural intervention.
The nurse stops the Lactated Ringer's, removes the old tubing to ensure no residual calcium remains, connects the new 0.9% Sodium Chloride, and immediately administers the ceftriaxone.
This sequence rapidly and safely resolves the incompatibility while implementing all provider orders.

Key Concept

Ceftriaxone is strictly contraindicated for concurrent administration with calcium-containing intravenous solutions (like Lactated Ringer's) due to the risk of fatal crystal precipitation.
Estimated Time:1m 30s
Rate this question

Topics

Pharmacological and Parenteral Therapies

More questions from this topic